Krog Anne H, Sahba Mehdi, Pettersen Erik M, Sandven Irene, Thorsby Per M, Jørgensen Jørgen J, Sundhagen Jon O, Kazmi Syed Ss
Institute of Clinical Medicine, University of Oslo; Department of Vascular Surgery, Division of Cardiovascular and Pulmonary Diseases, Oslo University Hospital, Oslo.
Department of Vascular Surgery, Østfold Central Hospital, Fredrikstad.
Vasc Health Risk Manag. 2016 Sep 26;12:371-378. doi: 10.2147/VHRM.S110600. eCollection 2016.
Minimally invasive surgical techniques have been shown to reduce the inflammatory response related to a surgical procedure. The main objective of our study was to measure the inflammatory response in patients undergoing a totally laparoscopic versus open aortobifemoral bypass surgery. This is the first randomized trial on subjects in this population.
This is a substudy of a larger randomized controlled multicenter trial (Norwegian Laparoscopic Aortic Surgery Trial). Thirty consecutive patients with severe aortoiliac occlusive disease eligible for aortobifemoral bypass surgery were randomized to either a totally laparoscopic (n=14) or an open surgical procedure (n=16). The inflammatory response was measured by perioperative monitoring of serum interleukin-6 (IL-6), IL-8, and C-reactive protein (CRP) at six different time points.
The inflammatory reaction caused by the laparoscopic procedure was reduced compared with open surgery. IL-6 was significantly lower after the laparoscopic procedure, measured by comparing area under the curve (AUC), and after adjusting for the confounding effect of coronary heart disease (=0.010). The differences in serum levels of IL-8 and CRP did not reach statistical significance.
In this substudy of a randomized controlled trial comparing laparoscopic and open aortobifemoral bypass surgeries, we found a decreased perioperative inflammatory response after the laparoscopic procedure measured by comparing AUC for serum IL-6.
微创外科技术已被证明可减少与手术相关的炎症反应。我们研究的主要目的是测量接受全腹腔镜与开放主动脉双股动脉搭桥手术患者的炎症反应。这是该人群中首个针对受试者的随机试验。
这是一项更大规模随机对照多中心试验（挪威腹腔镜主动脉手术试验）的子研究。连续30例符合主动脉双股动脉搭桥手术条件的严重主髂动脉闭塞性疾病患者被随机分为全腹腔镜手术组（n = 14）或开放手术组（n = 16）。通过在六个不同时间点围手术期监测血清白细胞介素-6（IL-6）、IL-8和C反应蛋白（CRP）来测量炎症反应。
与开放手术相比，腹腔镜手术引起的炎症反应减轻。通过比较曲线下面积（AUC）并校正冠心病的混杂效应后，腹腔镜手术后IL-6显著降低（P = 0.010）。IL-8和CRP血清水平的差异未达到统计学意义。
在这项比较腹腔镜与开放主动脉双股动脉搭桥手术的随机对照试验的子研究中，我们发现通过比较血清IL-6的AUC，腹腔镜手术后围手术期炎症反应降低。
